Provider Demographics
NPI:1922411289
Name:LANDRY, KRISTEN G (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:G
Last Name:LANDRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 N MEADOWS DR STE 220
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-7688
Mailing Address - Country:US
Mailing Address - Phone:614-259-0920
Mailing Address - Fax:614-259-0702
Practice Address - Street 1:5500 N MEADOWS DR STE 220
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-7688
Practice Address - Country:US
Practice Address - Phone:614-259-0920
Practice Address - Fax:614-259-0702
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.131934207R00000X, 208M00000X
OH351319342080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0239907Medicaid